TY 2015 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) Lorraine Auerbach...................................................................... President/CEO	40.00 .................	X	X			818,026	14,288
(2) William Trezza...................................................................... Chairman of the Board	10.00 .................	X	X			0	0
(3) Dan Dixon...................................................................... Vice Chairman	10.00 .................	X	X			0	0
(4) Philip Ruhl...................................................................... Director	10.00 .................	X				30,000	0
(5) Robert Lawrence...................................................................... Director	10.00 .................	X				0	0
(6) Brian Martucci...................................................................... Secretary	10.00 .................	X	X			0	0
(7) Hon Ron A Northup...................................................................... Director	10.00 .................	X				0	0
(8) Gary Giannini...................................................................... Director	10.00 .................	X				0	0
(9) Elizabeth Propp...................................................................... VP of Finance, CFO	40.00 .................		X			353,404	18,469
(10) Michael Glasberg...................................................................... VP of Operations, COO	40.00 .................			X		382,468	14,540
(11) Janine Hawkins...................................................................... VP of Patient Care Service	40.00 .................			X		299,559	28,746
(12) David Kerrins...................................................................... CIO (Through 12/08/2015)	40.00 .................			X		310,219	13,635
(13) Bradley Reinke...................................................................... VP of Medical Affairs, CMO	32.00 .................			X		242,690	0
(14) Chad Davis...................................................................... Registered Nurse	40.00 .................				X	226,837	15,031
(15) Terrance Thomas...................................................................... Registered Nurse	40.00 .................				X	216,441	20,864
(16) Shawn Fillon...................................................................... Registered Nurse	40.00 .................				X	200,692	13,428
(17) Ben Davidson...................................................................... Director of Finance/Controller	40.00 .................				X	198,026	15,507

(A)
Name and Title

(B)
Average hours per week (list any hours for related organizations below dotted line)

(D)
Reportable compensation from the organization (W- 2/1099-MISC)

(E)
Reportable compensation from related organizations (W- 2/1099-MISC)

(F)
Estimated amount of other compensation from the organization and related organizations

(1) Lorraine Auerbach......................................................................
President/CEO

40.00
.................

818,026

14,288

(2) William Trezza......................................................................
Chairman of the Board

10.00
.................

(3) Dan Dixon......................................................................
Vice Chairman

10.00
.................

(4) Philip Ruhl......................................................................
Director

10.00
.................

30,000

(5) Robert Lawrence......................................................................
Director

10.00
.................

(6) Brian Martucci......................................................................
Secretary

10.00
.................

(7) Hon Ron A Northup......................................................................
Director

10.00
.................

(8) Gary Giannini......................................................................
Director

10.00
.................

(9) Elizabeth Propp......................................................................
VP of Finance, CFO

40.00
.................

353,404

18,469

(10) Michael Glasberg......................................................................
VP of Operations, COO

40.00
.................

382,468

14,540

(11) Janine Hawkins......................................................................
VP of Patient Care Service

40.00
.................

299,559

28,746

(12) David Kerrins......................................................................
CIO (Through 12/08/2015)

40.00
.................

310,219

13,635

(13) Bradley Reinke......................................................................
VP of Medical Affairs, CMO

32.00
.................

242,690

(14) Chad Davis......................................................................
Registered Nurse

40.00
.................

226,837

15,031

(15) Terrance Thomas......................................................................
Registered Nurse

40.00
.................

216,441

20,864

(16) Shawn Fillon......................................................................
Registered Nurse

40.00
.................

200,692

13,428

(17) Ben Davidson......................................................................
Director of Finance/Controller

40.00
.................

198,026

15,507

(A)
Name and Title

(B)
Average hours per week (list any hours for related organizations below dotted line)

(D)
Reportable compensation from the organization (W- 2/1099-MISC)

(E)
Reportable compensation from related organizations (W- 2/1099-MISC)

(F)
Estimated amount of other compensation from the organization and related organizations

(18) Tresha Moreland........................................................................
VP of Human Resources

40.00
.......................

248,611

8,581

(19) William Chase........................................................................
Director of Finance (Through 4/2014)

0.00
.......................

153,333

(20) Christopher Arismendi........................................................................
Former CEO (Through 10/2012)

0.00
.......................

300,000

(21) Nicholas Arismendi........................................................................
Former COO (Through 7/2013)

0.00
.......................

131,250

(A) Name and business address	(B) Description of services	(C) Compensation
CPS LLC P O Box 638316 Cincinnati,OH45263	Pharmacy Services	4,963,016
Sound Physicians P O Box 742936 Los Angeles,CA90074	Hospitalist Services	2,387,865
Rehab Practice Management 9364 Ansley Avenue Brentwood,TN37027	Rehabilitation Services	1,025,199
Anesthesiology Consultants PO Box 13728 Sacramento,CA95853	Anesthesiology Services	920,707
Dialysis & Pheresis Technologies P O Box 692312 Stockton,CA95269	Renal Dialysis Services	640,275
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 21

(A)
Name and business address

(B)
Description of services

CPS LLC

P O Box 638316
Cincinnati,OH45263

Pharmacy Services

4,963,016

Sound Physicians

P O Box 742936
Los Angeles,CA90074

Hospitalist Services

2,387,865

Rehab Practice Management

9364 Ansley Avenue
Brentwood,TN37027

Rehabilitation Services

1,025,199

Anesthesiology Consultants

PO Box 13728
Sacramento,CA95853

Anesthesiology Services

920,707

Dialysis & Pheresis Technologies

P O Box 692312
Stockton,CA95269

Renal Dialysis Services

640,275

Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public
Inspection

Name of the organization

Dameron Hospital Association

Employer identification number

94-1201197

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support. Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2014. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2015. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513...
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support. (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2014. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2015 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ...	2d


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......	1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................	2e
3	Subtract line 2e from line 1..................	3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................	4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......	5

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........	1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................	2e
3	Subtract line 2e from line 1...................	3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................	4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......	5

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2015

Open to Public Inspection

Name of the organization

Dameron Hospital Association

Employer identification number

94-1201197

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 35000.0000000000 %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other 15000.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	18,089		18,089	0.010 %
b	Medicaid (from Worksheet 3, column a) . . . . .	52,818,739	28,570,174	24,248,565	12.920 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	52,836,828	28,570,174	24,266,654	12.930 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).	88,328		88,328	0.050 %
f	Health professions education (from Worksheet 5) . . .	11,250		11,250	0.010 %
g	Subsidized health services (from Worksheet 6) . . . .
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	146,037		146,037	0.080 %
j	Total. Other Benefits . .	245,615		245,615	0.140 %
k	Total. Add lines 7d and 7j .	53,082,443	28,570,174	24,512,269	13.070 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support	3	43,337	43,337	0.020 %
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building	1	250	250	0 %
7	Community health improvement advocacy	2	36,269	36,269	0.020 %
8	Workforce development	1	8,472	8,472	0 %
9	Other	3	157,287	157,287	0.080 %
10	Total	10	245,615	245,615	0.120 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

6,791,799

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

679,180

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

42,370,037

Enter Medicare allowable costs of care relating to payments on line 5.....

54,552,468

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-12,182,431

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2015

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Dameron Hospital Association 525 West Acacia Street Stockton,CA95203 www.dameronhospital.org 030000024	X	X	X

Schedule H (Form 990) 2015

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Dameron Hospital Association
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 13

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): www.dameronhospital.org

Other website (list url): www.healthiersanjoaquin.org

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): www.dameronhospital.org

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Dameron Hospital Association
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 350.000000000000% and FPG family income limit for eligibility for discounted care of 150.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

www.dameronhospital.org

The FAP application form was widely available on a website (list url):

www.dameronhospital.org

A plain language summary of the FAP was widely available on a website (list url):
www.dameronhospital.org

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2015

Page 6

Part VFacility Information (continued)

	Dameron Hospital Association
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that
can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2015

Page 7

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Dameron Hospital Association	Part V, Section B, Line 5: The robust and comprehensive assessment included both primary and secondary data. Primary data included input from more than 180 members of the Hospital Service Area (HSA), expert interviews with 45 key informants, focus group interviews with 137 community members and more than 300 community health assessnent surveys were collected. Secondary data included health outcome data, socio-demographic data, behavioral, and environmental data at the ZIP code or census tract level. Analysis of both primary and secondary data revealed 10 specific Communities of Concern, living with a high burden of disease in San Joaquin County. These 10 communities had consistently high rates of negative health outcomes that frequently exceeded county, state, and Healthy People 2020 benchmarks. The primary goals of the assessment are:- Engage local stakeholders- Generate knowledge that will lead to collaborative action- Identify data that would be useful for policy and advocacy work- Establish a "Call to Action" for community members- Assess community needs and assets- Develop a community dissemination plan- Provide ongoing tracking and monitoringRanking of the seven health needs are shown below:1. Lack of access to primary and preventative care services2. Lack of or limited access to health education3. Lack of or limited access to dental care4. Limited cultural competence in health and related systems5. Limited or no nutrition literacy/access to healthy and nutritious foods, food security6. Limited transportation options7. Lack of safe and affordable places to be active
Dameron Hospital Association	Part V, Section B, Line 6a: - St. Joseph's Medical Center- Lodi Memorial Hospital- Sutter Tracy Community Hospital- Kaiser Permanente
Dameron Hospital Association	Part V, Section B, Line 11: The implementation plan was developed following a distinct three step strategic planning process. First, the health needs identified in the CHNA were prioritized by members of the SJC2HAC. Second, Dameron Hospital selected four of the prioritized health needs as a primary focus for the purposes of meeting the health needs of the Community. Those chosen most closely aligned with the hospital's Mission and organizational capabilities. The third, and final step was the development of an implementation plan.Step 1: Prioritizing Health NeedsThe SJC2HAC prioritized and ranked the identified community health needs. Each health need was ranked along two dimensions: 1) the significance or severity of the health need; and 2) the ability of a hospital to make a notable impact on the identified health need.Step 2: Identify Health Needs for Dameron Hospital's 2015 focusDameron Hospital identified four primary health needs, from the seven, that aligned with its Mission and organizational capabilities. Dameron Hospital's Mission is to support physicians and our employees in providing quality patient care in a safe and caring environment.Step 3: Strategic PlanningThis process followed two key steps. First, personnel in the hospital were recruited to participate and develop the implementation plan. Second, Dameron Hospital leadership evaluated the implementation plan and its alignment to the community needs assessment. The final Plan is depicted in Strategic Plan (pgs. 20-22 of the Community Benefit Report) This evaluation and prioritization results were used as the roadmap for our 2015 Community Benefit Plan.

Schedule H (Form 990) 2015

Page 8

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2015

Page 9

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Part I, Line 7, Column (f):	The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 6,791,799.
Part II, Community Building Activities:	* Community support- "Books for Babies" is supported by our Volunteers who are associated with Tau Chapter of Delta Kappa Gamma (UOP Educators sorority). On a monthly basis, books are assembled both in English and Spanish and a plentiful supply for all new mothers is available on the Mother Baby Unit. This service is associated with San Joaquin County Healthier Community Coalition, which focuses on increasing reading literacy in our community. Dameron Hospital supplies the books necessary to maintain this important program.- Free Interpreter Services for patients and their designated support person.- Taxi/bus transportation to and from the Hospital/Clinic, if needed.* Coalition buildingDameron Hospital is an active participant in the San Joaquin County Healthier Community Coalition. The purposes of the Coalition are: a) to provide leadership in the development and coordination of health status improvement efforts in San Joaquin County; b) to provide a forum for health services stakeholders to share ideas and information about projects and seek collaborative partners; and c) to work collaboratively and encourage the efforts of other collaborative attempting to respond to community health issues and problems. Dameron Hospital collaborated on creating an all-inclusive free and confidential service helpline for local resources. The 211 helpline, launched in 2015, is available 24 hours a day, seven days a week. Dameron staff has co-chaired this Coalition and participated in key leadership roles since 2011. Its purpose is to make it easy for people to find the help they need, when they need it.* Community health improvement advocacyDameron has offered flu shot clinics in the community. In addition, Dameron's Linacia pharmacy has provided pharmaceuticals at no cost to a number of indigent patients.* Workforce developmentThis two-week program, sponsored by San Joaquin Medical Society, is designed to introduce high school students to the field of medicine through personal mentoring opportunities and site visits with behind-the-scenes access to some of our regional hospitals, clinics and public health centers. Decision Medicine 2015 took place at various locations in Northern California, including hospitals, various clinics and inside actual private offices of participating physicians in San Joaquin County. Decision Medicine 2015 at Dameron Hospital was a full eight-hour day including student interactive tours into the Core Laboratory, the Pathology Laboratory, American Medical Response ambulance tour, and a tour of the Hospital Data Center; didactic lectures on Basic Hematology & Comparative Cellular Morphology and Forensic Pathology; and hands-on laboratory exercises for Phlebotomy, Blood Specimen Preparation, Blood Smear Technique, Differential Staining Technique, Blood Smear Examination by Light Microscopy, and Blood Typing. In addition, students were provided an individual Complete Blood Analysis (CBC), a preliminary ABO blood group determination, historical information about Dameron Hospital and career information in pathology and laboratory medicine. Dameron Hospital hosted twenty-four students that included lunch and refreshments throughout the day. The Director of Risk Management coordinates this Program for Dameron Hospital. Volunteers include a Board Member, Chief Information Officer, Hospital Executive Leadership Team Member, Laboratory Medical Director, Laboratory Manager, several Clinical Laboratory Scientists, Patient Relations Coordinator, and Employee Relations Coordinator.* Other community building activityThe Institute for Medical Quality/California Medical Association (IMQ/CMA) provides Continuing Medical Education (CME) for physicians accredited at Dameron Hospital. Classes are offered at noon on Fridays (excluding Holidays and the months of July and August) in the hospital's Annex building. The classes are open to all physicians throughout the community. Dameron provided 27 continuing medical education classes throughout 2015 and will continue to provide Continuing Medical Education Classes in 2016. A total of 584 medical professionals attended the classes in 2015 and 91 other healthcare professionals. Dameron Hospital also provides staff, volunteer time, and meeting room space for community programs and organizations throughout San Joaquin County.- Meeting Space- Staff Participation- Bariatric support groups- NICU and Bariatric Support Groups - Stroke Soppurt Group-Healing Emotion- Healthier Community Coalition- Alpha Phi Chapter of Chi Eta Phi Nursing Society - Flu Shot Clinics- ACNL- AAUW (American Assoc. of University Women)- Lamaze Prepared Childbirth- Narcotic Anonymous- Chi Eta Phi Sorority Meeting - Healthy Lifestyles - No. California Stroke Coordinator Meeting - California Emergency HAM volunteers- NICU Support Group- Decision Medicine- NICU Support Group- Breastfeeding Coalition- NAMI Family to Family
Part III, Line 4:	The organization determines the amount that could be attributable to patients who likely would qualify for financial assistance under the hospital's financial assistance policy based upon a query of the collections system (Golden State Collections) - 10% of estimated bad debt expense.Any discounts and/or payments applied to a patient's account are not reversed before writing the account off to bad debt. In other words, the net balance of the account is what's written off.Bad debt expense is not included as a community benefit in the hospital's community benefit report.Bad Debt expense footnote - See audited financial statements, page 5, footnote 1, Patient accounts receivable and Allowance for uncollectible accounts sections.
Part III, Line 8:	If Medicare does not reimburse our costs for patient care, the excess of cost over reimbursement should be considered a benefit to the community we serve.Medicare uses the Medicare cost report program in computing the cost in providing medical care services for Medicare beneficiaries. The Medicare cost report calculates routine costs using per diem methodolgy and the ancillary cost is calculated using cost to charge ratios.
Part III, Line 9b:	In accordance with the Hospital's Charity Care and Discounted Payment Policy, patients will be made aware of the availability of Charity Care and Discounted Payment options on the Hospital's website, at all points of registration in the Hospital, as well as in connection with billing statements issued by the Hospital.The Patient Accounting Department sends the responsible party a final bill at least 90 days from the date the Hospital provides the first post-discharge billing statement, informing the responsible party of the Hospital's Charity Care and Discounted Payment Policy, a plain language summary of that policy and the patient's rights, as required under California Health and Safety Code section 127430(a), the phone number the responsible party can call for more information if interested in applying, the collections actions that may be pursued in the event of nonpayment, and the deadline for when those actions may be commenced (such deadline to be at least 30 days from the date of the final bill is sent). The Patient Accounting Department will also attempt to call or otherwise orally inform the responsible party of the Hospital's Charity Care and Discounted Payment Policy and how the responsible party may obtain assistance with the application process. The responsible party is requested to forward any insurance information or to make payment or submit an application under the Charity Care and Discounted Payment Policy within the stated deadline or the account may be referred to collections. Collections actions may include engaging a collection agency to assist with obtaining payment, reporting the patient's account to a consumer credit reporting agency, deferring, denying or requiring a payment before providing elective, non-Medically Necessary Services because of the patient's nonpayment of one or more bills for previously provided care, commencing a civil action against the patient for nonpayment, wage garnishment, bank garnishment and abstract liens on real property as well as business garnishment if responsible party is the business owner. However, for a patient that lacks coverage, the Hospital, any assignee of the Hospital, or other owner of the patient debt, including a collection agency, will not report adverse information to a consumer credit reporting agency or commence civil action against the patient for nonpayment at any time prior to 150 days after the initial billing. This period shall be extended if the patient has a pending appeal for coverage of the services until a final determination of the appeal is made.If the responsible party requests financial assistance, the request is forwarded to the Credit and Collections Department and the patient is sent an application under the Charity Care and Discounted Payment Policy identifying the charity process and the documentation required for processing. The responsible party is given 30 days to complete and return the application and supporting documents. If the collections process has already begun, it shall be suspended during this time. If an incomplete application is received, the Hospital will provide written notice describing additional information needed and will provide the contact information, including the telephone number and office location, of a person who can provide information about the Hospital's Charity Care and Discounted Payment Policy and assistance with completing the application.Collections shall remain suspended until a determination of eligibility is made or the Hospital has determined, after a reasonable period of time, the patient has failed to respond to requests for additional information to complete the application. If a complete application is received, the Hospital will determine the patient's eligibility and will notify the patient in writing of the determination and the basis for the determination. If the patient is determined to be eligible for assistance under the Charity Care and Discounted Payment Policy, (1) if such assistance is in the form of a discount, the patient will receive a billing statement that indicates the amount owed, how that amount was determined, and states or describes how the patient can obtain information regarding the Amount Generally Billed ("AGB") for the care provided, and (2) the patient will be refunded any amounts paid over the amount for which the patient has been determined under the Charity Care and Discounted Payment Policy to be responsible. The Hospital shall further take all reasonably available measures to address any adverse information reported to credit reporting agencies. The Hospital will accept applications under the Charity Care and Discounted Payment Policy until 240 days from the date the Hospital provides the first post-discharge billing statement.Extended payment plans for the amount owed may be arranged for those unable to pay their account in full pursuant to the Hospital's Charity Care and Discounted Payment Policy. Requests for payment plans exceeding the Hospital's schedule may be referred to the Hospital's designee for handling. If the account is not paid or satisfactory payment arrangements made, the account is sent for pre-collection to the Credit and Collections Department or its designee, as described in the Charity Care and Discounted Payment Policy. The Hospital may declare an extended payment plan (including a Reasonable Payment Plan) inoperative if the patient fails to make all consecutive payments during a 90-day period. Before declaring an extended payment plan inoperative, the Hospital, collection agency or assignee shall make a reasonable attempt to contact the patient by telephone, give written notice that the extended payment plan may become inoperative, and inform the patient that s/he may renegotiate the terms of the payment plan.
Part VI, Line 2:	Dameron Hospital is a member of the San Joaquin County Community Health Assessment Collaborative (SJC2HAC), responsible for producing and releasing, every three years, the Healthier San Joaquin County Dameron Hospital Association Community Benefit 2015 4 Community Assessment, required by Federal and State laws. In accordance with these legislative requirements, Dameron Hospital, in collaboration with other members of SJC2HAC, conducted an assessment of the community they serve, which encompasses all of San Joaquin County. Based on the results of this assessment, an Implementation Plan was developed detailing how the community needs will be addressed. This Plan is submitted annually to The California Office of Statewide Health Planning and Development (OSHPD), The Internal Revenue Service, and the Dameron Hospital Board of Directors. The Community Assessment was conducted over eight-months and was led by Valley Vision, Inc., a non-profit community consulting organization dedicated to improving the quality of life for residents across Northern California. The most recent SJC2HAC assessment was released in March 2013. The assessment is used to: inform and engage local stakeholders and community members, promote collaborative efforts based on data, solicitcommunity input and obtain group consensus in order to improve the health of our community. The Dameron Hospital Association 2015 Community Benefit Report reflects the 2013 SJC2HAC findings, our program, and activities to meet the identified needs of the community.
Part VI, Line 3:	The Hospital shall offer a paper copy of a plain language summary of the financial assistance policy to patients as part of the intake or discharge process, including for individuals who received emergency or outpatient care and were never admitted as inpatients. A conspicuous written notice on billing statements will notify and inform recipients about the availability of financial assistance under this Policy. Such notice shall provide the telephone number of the Hospital's department that can provide information about the Policy and the application process and the direct Website address where copies of the FAP, Financial Assistance Application form, and a plain language summary may be obtained. Signage regarding the Policy, how to obtain more information about the Policy and how to obtain copies of the Policy, the Financial Assistance Application form, and a plain language summary, is posted at all points of registration, including the emergency department, the billing office, the admissions office and other outpatient settings. Prior to commencing collection activities, the Hospital or its designee shall provide the patient with written notice containing a plain language summary of the patient's rights pursuant to California Health and Safety Code Section 127430(a), and a statement that nonprofit credit counseling services may be available in the area.The Hospital will, in addition to informing patients about this Policy, notify and inform members of the community about the availability of financial assistance under this Policy as well as how or where to obtain more information about the Policy and the Financial Assistance Application process and to obtain copies of the FAP, Financial Assistance Application form, and a plain language summary of the Policy.
Part VI, Line 4:	San Joaquin County is one of the original counties of California, created in 1850 and is located in the Central Valley of Northern California; home to approximately 730,000 residents. Stockton is the County seat, the largest incorporated city in the county and is home to almost half of the county's residents. San Joaquin County is one of the most agriculturally rich regions in California and known for its asparagus, strawberries, almonds, cherries, wine grapes and other abundant crops. The racial and ethnic makeup of county residents includes Whites (68.1%), African American (8.1%), and Native American 2.0%), Asian (15.9%), Pacific Islander (0.7%), and two or more races (4.9%). Hispanic or Latino origin includes (40.5%). According to the US Census (2010-2014v), almost 40% of all county residents speak a language other than English at home, and nearly one in four over the age of 25 does not have a high school diploma.San Joaquin County offers its residents affordable housing, abundant recreational facilities, excellent educational opportunities, and diverse cultural resources. As the northernmost county in the Central Valley, San Joaquin County includes the cities of Stockton, Lathrop, Lodi, Manteca, Ripon, Tracy, and Escalon, as well as numerous planned communities, census-designated areas, small towns and unincorporated areas.The U.S Census Bureau anticipates that San Joaquin County's population will reach 789,000 by 2020. Population change by ethnicity will also affect San Joaquin County; the largest increase over the next thirty years will come from an estimated 104.6% increase in the Hispanic/Latino population and the white population will decrease by 8.7%. This represents a significant shift in San Joaquin County demographics. In 2015, unemployment for the county was 8.9% compared to the state rate of 6.2%. San Joaquin County's population is slowly aging. The 2014 Census showed that people aged 60 and older now make up 11.8% of the population.According to the U.S. Census Bureau (2010-2014) San Joaquin County's median household income median is $53,253 household income, which aligns with the median income in the United States ($53,482), and in California ($45,437). It is important to note that a 20.7% of the San Joaquin County population lives below federal poverty level compared to the 16.4% rate in the state of California. Poverty is highest among children.
Part VI, Line 5:	In addition to our medical services and programs, Dameron Hospital also offers the following Community Benefit and outreach services:- Complimentary use of classroom for various community education and support groups- Volunteer Program for community members willing to donate their time in a health care environment- Sponsorship of health-related community events and activities- Donations of materials, equipment and supplies to community groups- Employee volunteer time- Taxi/bus transportation to and from the Hospital/Clinic, if needed- Continuing Medical Education for community physicians- Community education classes- Diabetic outpatient education program- Referral service to community sub-specialties at tertiary centers, for population age 21 of under- Unreimbursed Medi-Cal, Medicare, Charity Care, and Uninsured patient discounts- Participation in the Decision Medicine program exposing high school students to health care careers to encourage youth to give back to the community and consider a career in medicine- On-site free wireless Internet access and Notary Services- Workforce development- Health professional education- Management participation in local leadership programs and local school mentoring programs- Online health center "FollowMyHealth"- Physician recruitment in a medical shortage area- Staff participation in conducting community health needs assessments- Multilingual education classes- Provide a clinical setting for undergraduate/vocational training to students enrolled in outside programs- Free Interpreter Services for patients and their designated support person
Part VI, Line 6:	(not part of affiliated healthcare system)
Part VI, Line 7, Reports Filed With States	CA

Schedule H (Form 990) 2015

Additional Data

Software ID:
Software Version:

Return Reference

Explanation

Form 990, Part VI, Section B, line 11

Form 990 is reviewed by the CFO, Director of Finance, and Accounting Manager. The return is provided to the board for review prior to filing.

Form 990, Part VI, Section B, line 12c

Each individual Fiduciary must execute a Conflicts of Interest Disclosure Statement and Questionnaire at least annually and must promptly report all facts regarding any new transaction that might create a Conflict of Interest as soon as they become aware of any such transaction. It is each Fiduciary's duty to make a full disclosure as provided herein of all material facts regarding any possible conflict of interest, to describe the situation or transaction, and to disclose the details of the employee, medical staff officer, or Related Party's interest in the situation or transaction. All Fiduciaries shall report all possible conflicts of interest to the Chief Executive Officer, or her designee. The Chief Executive Officer, or designee, shall conduct such review as appropriate, and refer such information to the Board of Directors of the Hospital. The Board of Directors shall review such conflicts and disclosures. The Board of Directors may consult with legal counsel and such other authorities as may be desired, and may request any additional information deemed relevant, including the source and amount of any income or financial interest or other economic benefit to be derived by such person from the situation or transaction. It is the policy of the Board of Directors that the existence of ANY interest described within the Corporate Compliance & Regulatory Affairs policy shall be disclosed before any transaction is consummated. Each Fiduciary has a continuing responsibility to scrutinize any transaction in which the Fiduciary or a Related Party is directly or indirectly interested for potential conflict of interest and to make a full disclosure as provided herein. The Chief Executive Officer, or the Board of Directors shall as provided herein then determine whether a Conflict of Interest exists and shall take the appropriate action. All decisions regarding conflicts of interest rest in the sole discretion of the Board of Directors in the exercise of its ultimate judgment of the best interests of the Hospital. All officers who are employees, along with the rest of management and the Board are subject to an annual conflict of interest disclosure process.

Form 990, Part VI, Section B, line 15

In 2013 the organization established an executive compensation committee, which sets the policy each year and creates the compensation document. An outside independent consultant, Romanoff & Associates, provides salary ranges and market value used in setting compensation. Process was last done on May 25, 2016.

Form 990, Part VI, Section C, line 19

Financial statements are made available upon request. Governing documents and conflict of interest policy are not available to the public to view.

Form 990, Part IX, line 11g

Nurse Registry: Program service expenses 4,830,686. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,830,686. Other Contracted Services: Program service expenses 1,315,667. Management and general expenses 418,859. Fundraising expenses 0. Total expenses 1,734,526. Physicians Fees: Program service expenses 3,432,211. Management and general expenses 16,550. Fundraising expenses 0. Total expenses 3,448,761. Other Professional Fees: Program service expenses 828,194. Management and general expenses 884,285. Fundraising expenses 0. Total expenses 1,712,479. Pharmacy and Laboratory Outsourcing: Program service expenses 4,711,612. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,711,612. Maintenance: Program service expenses 2,683,057. Management and general expenses 89,851. Fundraising expenses 0. Total expenses 2,772,908. Medical records & Transcription services: Program service expenses 0. Management and general expenses 1,380,000. Fundraising expenses 0. Total expenses 1,380,000. Other Purchased Services: Program service expenses 4,653,856. Management and general expenses 2,737,589. Fundraising expenses 0. Total expenses 7,391,445.

1	Briefly describe the organization’s mission or most significant activities: We support physicians and our employees in providing quality care in a safe, caring environment.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	6
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	1,134
6	Total number of volunteers (estimate if necessary) .............	6	60
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	93,853
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	260	210
9	Program service revenue (Part VIII, line 2g) .........	184,625,035	232,844,153
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	219,715	824,947
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	175,722	588,070
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	185,020,732	234,257,380
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	87,162,772	90,704,238
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	97,861,095	103,808,474
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	185,023,867	194,512,712
19	Revenue less expenses. Subtract line 18 from line 12.......	-3,135	39,744,668
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	154,281,475	193,812,310
21	Total liabilities (Part X, line 26).............	29,560,088	30,520,788
22	Net assets or fund balances. Subtract line 21 from line 20.....	124,721,387	163,291,522

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 177,158,770 including grants of $ ) (Revenue $ 232,941,486 )
	Dameron Hospital is a fully accredited, 200+ bed, non-profit community hospital with specialized acute and tertiary care. Established in 1912, Dameron has been a trusted partner in San Joaquin County for over 100 years - and continues this leading-edge tradition under the current leadership of President and CEO Lorraine P. Auerbach.Over the past decade, Dameron's continued success has allowed us to expand our campus, upgrade facilities and equipment, and one of the county's largest private employers with over 900 employees and physicians.This commitment to providing the highest quality care has earned Dameron Hospital various state and national recognitions; including a national Five Star rating from Healthgrades for our Total Knee Replacements in 2015, and a designation by Blue Shield of California as a Blue Distinction Center in Bariatric Surgery as part of the Blue Distinction Centers for Specialty Care program. In addition to being a top-rated joint replacement center in the Stockton area, and the county's leading orthopedic hospital, Dameron also ranks in the top 10% for clinical performance among hospitals nationwide and has been recognized as a Top Performer for its Quality Metrics by the Joint Commission.The San Joaquin County Emergency Medical Services Agency has also named Dameron as a designated STEMI (heart attack) receiving center. Thanks to Dameron's LifeLine technology and cardiac-prepared ER staff, emergency responders now have a local care partner that is also a Certified Cardiac Care Hospital and a Cardiothoracic Surgery Center with an active Cardiac Catheterization Lab.Dameron Hospital continues its leading-edge tradition and we are continually enhancing our facilities and services to help fulfill our mission of delivering top quality care to the community. Dameron services include Cardiology and Cardiac Surgery, Orthopedics, Bariatric Surgery as well as general acute care, Emergency and Intensive Care Services. Dameron also provides primary care at our onsite Ambulatory Care Center.Dr. John Dameron founded Dameron Hospital in Stockton in 1912 with facilities for 20 patients. Ill health prompted him to sell the organization to a group of local doctors, staff and businessmen in 1925, and expansion in 1927 brought bed capacity up to 55.The hospital was incorporated as Dameron Hospital Association in 1943, becoming an independent, not-for-profit medical facility governed by a seven-person board of directors and a 20-member board of membership.Today we remain both independent and uncompromising in our approach to patient care - health care attitudes we've had from the very beginning. And with over 1,200 employees now on staff, we've gone from just serving the community to being a large part of it.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses177,158,770

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	4,111,556	0	163,089

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	210

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		210

		Business Code
2a	Patient Service Rev.	621110	100,171,371	100,171,371
b	Medical/Medicare Pymts	621110	61,458,208	61,458,208
c	Settlement	621110	43,850,000	43,850,000
d	Hospital Fee	621110	25,157,162	25,157,162
e	Cafeteria	722210	949,340	949,340
f	All other program service revenue.			1,258,072	1,258,072
g Total.Add lines 2a–2f.....			232,844,153

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			1,374,257			1,374,257
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		120,985
b	Less: rental expenses		149,931
c	Rental income or (loss)		-28,946
d	Net rental income or (loss)......			-28,946			-28,946
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,655,639
b	Less: cost or other basis and sales expenses		2,204,949
c	Gain or (loss)		-549,310
d	Net gain or (loss).....			-549,310			-549,310
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a		1,890,152
b	Less: cost of goods sold ..b		1,788,129
c	Net income or (loss) from sales of inventory..			102,023	97,333	4,690
Business Code			Miscellaneous Revenue
11a	Other Income		900099	425,830			425,830
b	Income from K-1		541900	89,163		89,163
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			514,993
12	Total revenue. See Instructions......			234,257,380	232,941,486	93,853	1,221,831

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	2,526,044		2,526,044
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....	584,583		584,583
7	Other salaries and wages	60,174,168	57,470,767	2,703,401
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	2,042,655	1,938,685	103,970
9	Other employee benefits .......	20,052,647	18,652,655	1,399,992
10	Payroll taxes ...........	5,324,141	5,025,994	298,147
11	Fees for services (non-employees):
a	Management ......	2,495,019	1,778,917	716,102
b	Legal .........	1,794,623		1,794,623
c	Accounting ...........	189,159		189,159
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	2,487		2,487
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	27,982,417	22,455,283	5,527,134
12	Advertising and promotion ....
13	Office expenses .......	28,638,141	28,404,048	234,093
14	Information technology ......	9,055,817	9,055,817
15	Royalties ..
16	Occupancy ...........	1,671,535	1,496,856	174,679
17	Travel ............	54,878	31,914	22,964
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	96,399	81,670	14,729
20	Interest ...........	76,782	76,782
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	7,886,007	7,886,007
23	Insurance ...	992,145		992,145
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medi-cal Hospital Fee E	15,957,361	15,957,361
b	Bad Debts Provision	6,791,799	6,791,799
c	Dues & Subscriptions	123,905	54,215	69,690
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	194,512,712	177,158,770	17,353,942	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			3,901	1	3,900
2	Savings and temporary cash investments .........			1,573,755	2	61,227,265
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			33,783,195	4	27,986,653
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net ....			689,212	7	617,553
8	Inventories for sale or use ........			3,184,513	8	3,538,329
9	Prepaid expenses and deferred charges ......			2,222,653	9	1,583,795
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	182,915,369
b	Less: accumulated depreciation	10b	129,267,658	58,246,773	10c	53,647,711
11	Investments—publicly traded securities .			35,234,701	11	32,477,331
12	Investments—other securities. See Part IV, line 11 .....			5,244,467	12	4,130,792
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			14,098,305	15	8,598,981
16	Total assets. Add lines 1 through 15 (must equal line 34)...			154,281,475	16	193,812,310

17	Accounts payable and accrued expenses .....	17,309,013	17	19,179,131
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..	1,961,338	23	0
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D	10,289,737	25	11,341,657
26	Total liabilities. Add lines 17 through 25..	29,560,088	26	30,520,788

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	124,382,218	27	162,587,284
28	Temporarily restricted net assets ...........	339,169	28	704,238
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	124,721,387	33	163,291,522
34	Total liabilities and net assets/fund balances ........	154,281,475	34	193,812,310

1	Total number at end of year ....
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ....

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

1a	Land ...		4,268,040		4,268,040
b	Buildings	1,995,756	80,293,418	49,660,152	32,629,022
c	Leasehold improvements		1,560,764	1,080,648	480,116
d	Equipment ...		86,918,715	74,416,539	12,502,176
e	Other ...		7,878,676	4,110,319	3,768,357
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					53,647,711

(a) Description of security or category (including name of security)	(b)Book value	(c)Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Risk Management Programs	7,776,969
Retiree Medical Liability	3,564,688
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	11,341,657
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Lorraine AuerbachPresident/CEO	(i) (ii)	596,629 ------------- 0	210,870 ------------- 0	10,527 ------------- 0	0 ------------- 0	14,288 ------------- 0	832,314 ------------- 0	0 ------------- 0
2Elizabeth ProppVP of Finance, CFO	(i) (ii)	298,226 ------------- 0	55,178 ------------- 0	0 ------------- 0	5,556 ------------- 0	12,913 ------------- 0	371,873 ------------- 0	0 ------------- 0
3Michael GlasbergVP of Operations, COO	(i) (ii)	307,699 ------------- 0	74,769 ------------- 0	0 ------------- 0	7,152 ------------- 0	7,388 ------------- 0	397,008 ------------- 0	0 ------------- 0
4Janine HawkinsVP of Patient Care Service	(i) (ii)	241,153 ------------- 0	49,289 ------------- 0	9,117 ------------- 0	14,478 ------------- 0	14,268 ------------- 0	328,305 ------------- 0	0 ------------- 0
5David KerrinsCIO (Through 12/08/2015)	(i) (ii)	229,826 ------------- 0	50,475 ------------- 0	29,918 ------------- 0	0 ------------- 0	13,635 ------------- 0	323,854 ------------- 0	0 ------------- 0
6Bradley ReinkeVP of Medical Affairs, CMO	(i) (ii)	242,690 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	242,690 ------------- 0	0 ------------- 0
7Chad DavisRegistered Nurse	(i) (ii)	226,837 ------------- 0	0 ------------- 0	0 ------------- 0	7,643 ------------- 0	7,388 ------------- 0	241,868 ------------- 0	0 ------------- 0
8Terrance ThomasRegistered Nurse	(i) (ii)	216,441 ------------- 0	0 ------------- 0	0 ------------- 0	7,583 ------------- 0	13,281 ------------- 0	237,305 ------------- 0	0 ------------- 0
9Shawn FillonRegistered Nurse	(i) (ii)	198,492 ------------- 0	0 ------------- 0	2,200 ------------- 0	5,895 ------------- 0	7,533 ------------- 0	214,120 ------------- 0	0 ------------- 0
10Ben DavidsonDirector of Finance/Controller	(i) (ii)	172,473 ------------- 0	22,289 ------------- 0	3,264 ------------- 0	4,311 ------------- 0	11,196 ------------- 0	213,533 ------------- 0	0 ------------- 0
11Tresha MorelandVP of Human Resources	(i) (ii)	217,006 ------------- 0	30,789 ------------- 0	816 ------------- 0	0 ------------- 0	8,581 ------------- 0	257,192 ------------- 0	0 ------------- 0
12William ChaseDirector of Finance (Through 4/2014)	(i) (ii)	0 ------------- 0	0 ------------- 0	153,333 ------------- 0	0 ------------- 0	0 ------------- 0	153,333 ------------- 0	0 ------------- 0
13Christopher ArismendiFormer CEO (Through 10/2012)	(i) (ii)	0 ------------- 0	0 ------------- 0	300,000 ------------- 0	0 ------------- 0	0 ------------- 0	300,000 ------------- 0	0 ------------- 0
14Nicholas ArismendiFormer COO (Through 7/2013)	(i) (ii)	0 ------------- 0	0 ------------- 0	131,250 ------------- 0	0 ------------- 0	0 ------------- 0	131,250 ------------- 0	0 ------------- 0